Understanding Borderline Personality Disorder and Anger

An intense symptom that often triggers aggressive behavior

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Intense, inappropriate anger is one of the most troubling symptoms of borderline personality disorder (BPD). In fact, it's so intense that it's often referred to as “borderline rage.”

Even so, while anger is a key feature of BPD, very little is known about why people with BPD experience anger differently than other people or how this experience is different.

New research, however, is shedding light on the nature of borderline rage.

Basics of Borderline Anger

Borderline anger is more than just a standard emotional reaction. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, anger in BPD is described as "inappropriate, intense anger or difficulty controlling anger."

The reason anger in BPD is called “inappropriate,” is because the level of anger seems to be more intense than is warranted by the situation or event that triggered it. For example, a person with BPD may react to an event that may seem small or unimportant to someone else, such as a misunderstanding, with very strong feelings of anger and unhealthy expressions of anger, such as yelling, being sarcastic, or becoming physically violent. 

Research on Borderline Anger

While borderline anger has long been a topic of debate and speculation among BPD specialists, it has only recently become a focus of careful research. Experts are now examining how borderline anger is different than normal anger and why it occurs.

More specifically, researchers are trying to understand whether it's that people with BPD are more easily angered, have more intense anger responses, or have more prolonged anger responses than people without BPD (or whether it's some combination of these factors).

One study examined anger in people with BPD compared to people without BPD, in response to an anger-producing story.

This study found that people with BPD reported the same level of anger as the healthy controls (in response to the story). But, the healthy controls reported that their anger decreased more quickly over time than the people with BPD reported.

So it may not be that people with BPD have a stronger anger reaction, but that their anger has a much longer duration than other people experience.

Furthermore, other research shows that anger in BPD may trigger rumination (when someone thinks over and over about his or her angry experience). This repetitive thinking creates a vicious emotional cycle that worsens the person's anger and increases its duration (as supported by the study mentioned above). Eventually, the prolonged and intense anger triggers aggressive behavior, which a person engages in to relieve their rage 

Research in this area is very preliminary, and much more work is needed to fully understand how and why people with BPD experience borderline anger. 

Treatment of Borderline Anger

There are a number of therapies that can be used to treat borderline personality disorder, including the often debilitating symptom of anger. 

Psychotherapy
Most psychotherapies for BPD target the strong anger responses that people with BPD report and exhibit.

For example, in dialectical behavior therapy (DBT), patients are taught skills to help them better manage their anger and decrease angry outbursts. Other types of psychotherapy for BPD, including schema-focused therapy, transference-focused therapy, and mentalization-based therapy, target anger as well.

Medications
While there are no medications for BPD that are currently FDA approved to treat the disorder, there are some that have been shown to reduce anger in BPD. However, these BPD medications are probably most effective when used in conjunction with psychotherapy. This is because while medications can alter the intensity of anger, they cannot fully prevent or erase a person's anger when a life stressor or difficult situation arises.

A Word From Verywell

If you or a loved one has difficulties with borderline anger, please seek out care from a therapist or other mental health professional. You (or your loved one) can gain control over this distressing symptom and feel better. 

On a final note, it's important to remember that anger itself is a normal emotion, so experiencing angry reactions does not mean you have BPD. Remember, a person with borderline personality disorder experiences frequent, extreme, and inappropriate anger outbursts that often lead to destructive behaviors like physical fights.

Still, if you have difficulties with anger control, reaching out to a mental health professional is a good idea. 

Sources:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th edition. 2013

Jacob GA et al. Time course of anger and other emotions in women with borderline personality disorder: a preliminary study. J Behav Ther Exp Psychiatry. 2008 Sep;39(3):391-402.

Martino F. Anger and depressive ruminations as predictors of dysregulated behaviors in borderline personality disorder. Clin Psychol Psychother. 2017 Oct 11. 

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